Healthcare Provider Details

I. General information

NPI: 1548274368
Provider Name (Legal Business Name): SCOTT GAREY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 DIABLO RD SUITE 110
DANVILLE CA
94526-3481
US

IV. Provider business mailing address

315 DIABLO RD SUITE 110
DANVILLE CA
94526-3481
US

V. Phone/Fax

Practice location:
  • Phone: 925-855-8350
  • Fax: 925-855-8351
Mailing address:
  • Phone: 925-855-8350
  • Fax: 925-855-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: